As swimsuit weather and prom season bear down once again on fair-skinned, teenaged New Yorkers, the debate heats up: To tan or not to tan?

In May, the federal government required manufacturers to more accurately inform that choice. Still others are opting for a spray-on glow that avoids possible health risks and skirts age constraints.

For years, medical groups have urged the U.S. government to take action on tanning beds because of rising rates of skin cancer among teenagers and 20-somethings, particularly women.

More than 76,000 new cases of melanoma, the deadliest form of skin cancer, are expected to be diagnosed this year, and the disease is expected to cause 9,710 deaths, according to the American Cancer Society.

Although most cases are diagnosed in people in their 40s and 50s, the disease is linked to sun exposure at a young age. Melanoma is also the second-most common form of cancer among young adults, according to the American Academy of Dermatology (AAD).

This year, an estimated 2.3 million U.S. teenagers will once again tan indoors, the AAD asserts.

But this year, tanning beds and sun lamps will carry new warnings that they should not be used by anyone under age 18, part of a government action aimed at reducing rising rates of skin cancer linked to the radiation-emitting devices.

The Food and Drug Administration has regulated tanning machines for more than 30 years, but the agency is now requiring more prominent warnings about the cancer risks of indoor tanning. Makers of sun lamps and related devices must include a bold label, known as a black box warning, stating that they should not be used by people under age 18.

A spokeswoman for the American Academy of Dermatology said she hoped the federal move would spur more states to take action. Twenty-four states already have laws banning minors from using indoor tanning equipment.

“The FDA has taken a very strong stand about indoor tanning, and this will, I think, really encourage additional states to strengthen their indoor tanning restrictions,” said Dr. Mary Maloney of the University of Massachusetts Medical School.

Additionally, manufacturers must provide more warnings about cancer risks in pamphlets, catalogues and websites that promote indoor tanning. Those materials must warn that the devices shouldn’t be used by people who have had skin cancer or have a family history of the disease.

The FDA is also requiring manufacturers to meet certain safety and design requirements, including timers and limits on radiation emitted. Previously, tanning devices were not subject to any preliminary review by health regulators.

State regulations

Despite the mandated written warnings, Ontario County Public Health Director Mary Beer is concerned with the surging interest among teens in UV tanning.

“I just wish they could find another alternative like spray tans or lotions,” she said. “They don’t see it now, but they’re putting themselves at risk for skin cancer.”

Page 2 of 6 - Perhaps as products continue to improve, alternatives to UV tanning will become more popular, she said. But even suntanning out by the pool is dangerous.

“We all enjoy the sun — we don’t get enough of it around here,” she said. “But people feel as though they look better with a little bit of a tan.”

As of Aug. 15, 2012, state Department of Health regulations prohibit individuals under the age of 17 from using UV radiation devices. Further, it requires that individuals 17 to 18 years old have a parent or legal guardian sign a consent form before using UV radiation devices. People 18 years or older must provide a driver's license or other photo identification, issued by either a government agency or educational institution, before using UV radiation devices.

Besides New York, other states regulating or banning minors' use of tanning devices include California, Illinois, Louisiana, Minnesota, Nevada, Oregon, Texas and Vermont.

New York’s health department states that “sunburned or tanned skin is damaged skin. Most of a person's lifetime skin damage, which increases the risk for skin cancer, occurs before the age of 18. Therefore, even if a child's sunburn or tan fades, the damage caused by that tan or burn does not and the effects cannot be reversed. The damage keeps adding up with each sunburn or tan and may one day result in skin cancer. So, it is important that both children and adults protect their skin.”

The state regulation also requires that the facility provide all patrons with the state Health Department information sheet that warns of health risks and conditions under which UV radiation is not advised. Patrons must sign a statement of acknowledgement that they are aware of the risks, and a consent form.

Beer said the state health department’s regional office in Geneva is responsible for inspecting all of the tanning establishments in Ontario, Wayne and Yates counties every two years to make sure they’re in compliance with state regulation.

Science speaks

According to research by the Centers for Disease Control and Prevention (CDC), high-risk UV exposure happens more commonly in teens, and ultimately the blistering sunburns and overexposure during childhood will greatly increase the chances of developing skin cancer later in life.

If current trends continue, CDC research indicates, one in five Americans will get skin cancer in their lifetime. And people who use tanning beds are more likely to get skin cancer, including melanoma, which can be deadly, the research stated.

To put it in perspective, an estimated 419,000 skin cancer cases are believed to be caused by indoor tanning each year in the U.S. alone. That’s nearly double the estimated 226,000 lung cancer cases believed to be caused by smoking each year in the U.S.

To further bring attention to indoor tanning as a public health problem, CDC scientists published two papers in 2013 in a special issue of the American Journal of Preventive Medicine to discuss ways to reduce indoor tanning and prevent future cases of skin cancer. One was "Preventing Skin Cancer Through Reduction of Indoor Tanning: Current Evidence,” led by Meg Watson, and the other was “Strategies to Reduce Indoor Tanning: Current Research Gaps and Future Opportunities for Prevention,” led by Dawn Holman.

Page 3 of 6 - Researchers noted in the papers that one in three white women between 18 and 21 years of age have tanned indoors in the past 12 months, with an average of more than 27 times per year. Many U.S. high school students also use tanning beds often, with about half of high school indoor tanners using them 10 or more times per year. Nearly three-fourths of tanning salons let people use tanning beds too often, research indicates, and state laws on indoor tanning are rarely enforced, it concluded.

A parent’s perspective

Michael Torpey of Rochester has four kids fast approaching tanning age. His plan is to promote healthy alternatives to UV tanning, and avoid enabling poor choices.

“The science behind tanning and the use of tanning beds is undeniable,” said Torpey. “Tanning has a variety of nasty side effects up to and including looking prematurely old and contracting skin cancer. So it is definitely my responsibility as a parent to make certain my kids are aware of that science and can visualize the long-term effects.”

At the same time, he said he has a hard time ethically saying “don’t tan,” because in his mind, it borders on hypocrisy.

“I love sweets, also known to be bad for your health over the long term, and overindulgence leads me to carry a few extra pounds,” Torpey reasoned. “Every one of us could come up with examples of where we take unnecessary risks for some selfish or vain reason, like talking on the cell phone while driving, driving too fast, eating bacon, not getting enough sleep ...”

A healthier alternative

Twenty-one-year-old Ashley Bleier has been working at darkTan on Eastern Boulevard in Canandaigua for almost four years now. Before that she was an avid UV tanner, but in recent years, preserving the youthful appearance of her skin has pushed forward in importance. These days she’s proud to say she rarely UV tans, doesn’t smoke and doesn’t drink — all steps to take care of herself.

“I started UV tanning when I was 15 — that was before New York state came out with all the laws and regulations,” said Bleier. “I don’t know if it clicked one day and I realized I didn’t want to be doing that anymore. After awhile I thought, ‘I’m going to start looking after my skin.’”

She still UV tans occasionally — about once every two months “just because it’s an awesome way to relax.” Clients come in for medical, psychological and appearance purposes, she said.

“I’ve got people who come in here who have fibromyalgia or who have been diagnosed with depression and they’ll come in with doctor’s notes, because it just makes you happy,” she said. “When people get cabin fever during the wintertime, that’s our busiest season.”

Page 4 of 6 - There was a lot more activity in the Mystic Tan booth with ball and prom season, Bleier said. Parents who may not want their kids to UV tan will allow the spray, or Mystic, alternative for their under-18 teens.

“It’s not a spray tan, per se,” said Bleier. “It’s a mist that goes on your body and we customize it here for you. You can tell me how dark you want it to be, tell me what you want it to smell like, I’ll make it happen.”

“I usually keep my color about a week and a half,” said Bleier. “I say it’s like waxing a car — you’ve got to take care of it for it to look good.”

About 20 percent of customers spray tan and about 80 percent are avid UV tanners, Bleier estimated. They come on their lunch break or before or after work and sometimes just to drop by and chat. The cost for either is similar — a month of spray tanning is about $50 and a month of UV is about $40, she said.

Terry Urzetta of Victor has owned her own spray-tanning business since 2007. Her clients range in age from teens through women in their 60s and 70s — many of whom have accumulated years of sun damage, she said.

Urzetta also admits having spent her share of time under UV lamps and in the Florida sun over the years, and said she has “a lot of sun damage” as a result. But she loves being outdoors and now protects herself with liberal doses of sunscreen. She’s seen the downside of sun damage, though.

“I’ve had many, many clients under the age of 30 who have had skin cancer,” said Urzetta. “It’s not a choice for them to UV tan. I think I offer a safe alternative. Everyone wants that healthy glow.”

Urzetta uses an all-natural product, which is odorless, free of orange tint and free of chemicals, parabens and dyes. She has clients who come in once, two days before heading off on a vacation, so when they get to their destination they already have a tan that will last seven to 10 days. She has also spray-tanned girls 11 and 12 who were preparing for an Irish dance competition.

“The products have definitely gotten better in the last 10 years,” Urzetta said. “There’s no fear of getting orange. The application has definitely changed, the equipment is very modern and it just keeps improving.”

At Michelle’s Salon and Spa, and at Park West Hair Design — both in Canandaigua — spray tanning is one of many options for soon-to-be brides, vacationers or students getting ready for a big event.

Sandy Hershey of Park West reported that “a lot of the girls do it for senior ball, junior prom or homecoming, for a special night or to get ready to go on vacation.”

Page 5 of 6 - “You’ll still need to wear sunscreen,” she said, “but it helps so you don’t look out of place that first day on the beach.”

In Victor, a phone call and $30 or more will bring the tanning salon to your home or party courtesy of Bronze to You Mobile Spray Tanning.

Despite the risk, Canandaigua resident Kris Macumber, 56, said she loves UV tanning — enough to go two to three times a week all year long.

“I get depressed in the winter, and between tanning and exercise, it really helps the seasonal depression,” she said. “I can never get warm, and it is hard for me to relax, and tanning helps with both. I am an unashamed tanner and I will probably always tan — and yes, I know that it causes premature aging and skin damage, but there you have it.”

By the numbers

419,000 — number of skin cancer cases believed to be caused by indoor tanning annually in the U.S.

226,000 — number of lung cancer cases believed to be caused by smoking annually in the U.S.

(Centers for Disease Control and Prevention)

13 percent of all high school students engage in indoor tanning

21 percent of high school girls engage in indoor tanning

32 percent of girls in the 12th grade engage in indoor tanning

29 percent of white high school girls engage in indoor tanning

(2011 Youth Risk Behavior Surveillance System)

Did you know?

— One in three white women between 18 and 21 years of age have tanned indoors in the past 12 months

— Those who tan do so an average of more than 27 times per year.

— Many U.S. high school students also use tanning beds often.

— About half of high school indoor tanners use them 10 or more times per year.

Indoor tanning and tanning outside are both dangerous. Although indoor tanning devices operate on a timer, the exposure to UV rays can vary based on the age and type of light bulbs. Indoor tanning is designed to give you high levels of UV radiation in a short time. You can get a burn from tanning indoors, and even a tan indicates damage to your skin.

“A base tan will protect me from getting a sunburn.”

Indoor tanning does not protect against sunburn. In fact, a tan only provides a sun protection factor (SPF) of about 3. The Centers for Disease Control and Prevention recommends sunscreen with an SPF of at least 15. The important thing to remember is that a tan is a response to injury: skin cells respond to damage from UV rays by producing more pigment.

Page 6 of 6 - “Indoor tanning is a safe way to get vitamin D, which prevents many health problems.”

Vitamin D is important for bone health, but its effect on other health problems is less clear. Although it is important to get enough vitamin D, the safest way is through diet or supplements. Tanning harms your skin, and the amount of UV exposure you need to get enough vitamin D is hard to measure because it is different for every person.